<!doctype html>
<html>
	<head>
		<title>Last Name</title>
	</head>
	<body>
		<table border="1px">
			<tbody>
				<tr>
					<td>Last Name</td>
					<td>
						<form>
							<input type="text" name="Last Name" value="Nakov" />
						</form>
					</td>
				</tr>
				<tr>
					<td>First Name</td>
					<td>
						<form>
							<input type="text" name="First Name" value="Svetlin"/>
						</form>
					</td>
				</tr>
				<tr>
					<td>Adress</td>
					<td>
						<form>
							<textarea name="Comments"> 17 Hristo Botev Str floor 3 apt 12 </textarea>
						</form>
					</td>
				</tr>
				<tr>
					<td>City</td>
					<td>
						<table border="0px">
							<tr>
								<td>
									<input type="text" name="City" value="Kaspichan" />
								</td>
								<td>State</td>
								<td>
									<input type="text" name="State" />
								</td>
							</tr>
						</table>
					</td>
				</tr>
				<tr>
					<td>Zip/Postal code</td>
					<td>
						<input type="text" name="Zip" value="9325" />
					</td>
				</tr>
				<tr>
					<td>Country</td>
					<td>
						<select name="country">
						<option value="Value1" selected="selected">Bulgaria</option>
					</td>
				</tr>
				<tr>
					<td>Phone</td>
					<td>
						<div>(+ <input type="text" name="First number" value="359" />)<input type="text" name="Second number" value="88" /> -<input type="text" name="Last number" value="8334343" /></div>
					</td>
				</tr>
				<tr>
					<td>E-mail</td>
					<td>
						<input type="text" name="email" value="nakov@kaspichan.org" />
					</td>
				</tr>
				<tr>
					<td>Birth date</td>
					<td>
						<div>Month<input type="text" name="month" value="06" />day<input type="text" name="day" value="14" />year(4digit)<input type="text" name="year" value="1980" /></div>
					</td>
				</tr>
				<tr>
					<td>Gender</td>
					<td>
						<select name="gender">
						<option value="Value1" selected="selected">Male</option>
					</td>
				</tr>
				<tr>
					<td>Starting date</td>
					<td>
						<input type="radio" name="gender" value="male" />Spring 2006<input type="radio" name="gender" value="female" />Summer 2006
					</td>
				</tr>
				<tr>
					<td>Comments/Questions</td>
					<td>
						<form>
							<textarea name="Comments"> Please send me more information about the loging. </textarea>
						</form>
					</td>
				</tr>
			</tbody>
		</table>
	</body>
</html>